Impacto de los polimorfismos genéticos en la efectividad de intervenciones nutricionales frente a tratamientos farmacológicos en niños y adolescentes con obesidad
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Date
2025
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Publisher
PUCE - Quito
Abstract
La obesidad en niños y adolescentes constituye un desafío prioritario de salud pública, no solo por su elevada prevalencia, sino también por las complicaciones metabólicas, cardiovasculares y psicosociales asociadas. Además de los determinantes ambientales y conductuales, se reconoce la influencia de polimorfismos genéticos que pueden condicionar la predisposición al exceso de peso y modular la respuesta a distintas intervenciones. En este contexto, resulta pertinente analizar el impacto de dichos polimorfismos para comprender su papel en la efectividad de las estrategias nutricionales y farmacológicas, y avanzar hacia un abordaje más personalizado de la obesidad pediátrica.
Con este propósito, se realizó una revisión sistemática rápida siguiendo las directrices PRISMA y el Cochrane Handbook, que incluyó 19 ensayos clínicos en población de 8 a 16 años provenientes de diversas regiones, principalmente Europa, Japón, Estados Unidos y Latinoamérica. Los tamaños muestrales oscilaron entre 75 y más de 500 participantes. Los genes más investigados fueron FTO, MC4R, ADRB3, LEPR, TMEM18 e IL6. En conjunto, los estudios sugieren que estos polimorfismos se asocian con variabilidad en los efectos de intervenciones basadas en dieta, ejercicio y, en algunos casos, tratamientos farmacológicos, observándose diferencias en la reducción del índice de masa corporal, la composición corporal y marcadores metabólicos como el perfil lipídico y la sensibilidad a la insulina.
Los hallazgos evidenciaron una heterogeneidad considerable entre los estudios, atribuible a diferencias metodológicas, características de las muestras y herramientas empleadas. Si bien algunos trabajos reportaron asociaciones significativas entre determinados alelos y la respuesta terapéutica, otros no confirmaron dichos resultados. No obstante, se observa un consenso creciente sobre la relevancia de integrar la genómica en la atención clínica pediátrica, promoviendo estrategias de prevención y tratamiento personalizadas, multidimensionales y costo-efectivas, orientadas a optimizar la calidad de vida de niños y adolescentes con obesidad.
Childhood and adolescent obesity constitutes a major public health challenge, not only because of its high prevalence but also due to the associated metabolic, cardiovascular, and psychosocial complications. In addition to environmental and behavioral determinants, the influence of genetic polymorphisms is increasingly recognized, as they may affect susceptibility to excess weight and modulate responses to different interventions. In this context, analyzing the impact of these polymorphisms is relevant to better understand their role in the effectiveness of nutritional and pharmacological strategies and to move toward a more personalized approach to pediatric obesity. To this end, a rapid systematic review was conducted following PRISMA guidelines and the Cochrane Handbook. The review included 19 clinical trials involving participants aged 8 to 16 years from multiple regions, mainly Europe, Japan, the United States, and Latin America. Sample sizes ranged from 75 to more than 500 participants. The most frequently studied genes were FTO, MC4R, ADRB3, LEPR, TMEM18, and IL6. Overall, the studies suggest that these polymorphisms are associated with variability in the effects of diet- and exercise based interventions and, in some cases, pharmacological treatments. Differences were observed in body mass index reduction, body composition, and metabolic markers such as lipid profile and insulin sensitivity. The findings showed considerable heterogeneity across studies, attributable to methodological differences, sample characteristics, and the tools used. While some studies reported significant associations between certain alleles and therapeutic response, others did not confirm these results. Nevertheless, there is growing consensus on the importance of integrating genomics into pediatric clinical care, promoting personalized, multidimensional, and cost-effective prevention and treatment strategies aimed at optimizing the quality of life of children and adolescents living with obesity.
Childhood and adolescent obesity constitutes a major public health challenge, not only because of its high prevalence but also due to the associated metabolic, cardiovascular, and psychosocial complications. In addition to environmental and behavioral determinants, the influence of genetic polymorphisms is increasingly recognized, as they may affect susceptibility to excess weight and modulate responses to different interventions. In this context, analyzing the impact of these polymorphisms is relevant to better understand their role in the effectiveness of nutritional and pharmacological strategies and to move toward a more personalized approach to pediatric obesity. To this end, a rapid systematic review was conducted following PRISMA guidelines and the Cochrane Handbook. The review included 19 clinical trials involving participants aged 8 to 16 years from multiple regions, mainly Europe, Japan, the United States, and Latin America. Sample sizes ranged from 75 to more than 500 participants. The most frequently studied genes were FTO, MC4R, ADRB3, LEPR, TMEM18, and IL6. Overall, the studies suggest that these polymorphisms are associated with variability in the effects of diet- and exercise based interventions and, in some cases, pharmacological treatments. Differences were observed in body mass index reduction, body composition, and metabolic markers such as lipid profile and insulin sensitivity. The findings showed considerable heterogeneity across studies, attributable to methodological differences, sample characteristics, and the tools used. While some studies reported significant associations between certain alleles and therapeutic response, others did not confirm these results. Nevertheless, there is growing consensus on the importance of integrating genomics into pediatric clinical care, promoting personalized, multidimensional, and cost-effective prevention and treatment strategies aimed at optimizing the quality of life of children and adolescents living with obesity.
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Keywords
Obesidad infantil, Polimorfismo genético, Nutrición del niño, Intervención nutricional - Adolescentes, Farmacogenética, Medicina de precisión, Resistencia a la insulina - Genética, Revisión sistemática, Pediatric obesity, Genetic polymorphisms, Nutritional interventions, Pharmacotherapy, Personalized medicine